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At least 19 recordsLinked to original sources
PubMed1995

Intraocular pressure response to combined phacoemulsification and trabeculotomy ab externo versus phacoemulsification alone in primary open-angle glaucoma.

We investigated trabeculotomy ab externo as a means of optimizing intraocular pressure (IOP) control in glaucoma patients having phacoemulsification and implantation of an intraocular lens (IOL). A prospective, randomized, controlled study was performed to evaluate the effect on IOP and the incidence of complications associated with combined phacoemulsification and trabeculotomy ab externo. The study group had the combined procedure, while the control group had only phacoemulsification with IOL implantation. A total of 106 patients were randomized, and the IOP for each group was compared at 3, 6, 12, and 24 months. At two years, the mean IOP reduction was 6.1 mm Hg in the study group and 3.8 mm Hg in the control group (P = .001). There were no complications in the control group. Two complications (2/53 or 3.8%) occurred in the study group: a small tear in Descemet's membrane and a postoperative microhyphema. There was no increase in medication in either the study or control group. Combined phacoemulsification and trabeculotomy ab externo represents an option to lower IOP and potentially reduce the need for pressure-lowering medications in patients with primary open-angle glaucoma and visually significant cataracts.

Aged↗
PubMed1995

Comparison of endothelial cell loss and phacoemulsification energy during endocapsular phacoemulsification surgery.

We counted central corneal endothelial cells and measured corneal thickness in 64 human eyes before and three months after cataract extraction and posterior chamber lens implantation. Cataract surgery was the same in all patients and included capsulorhexis and posterior chamber phacoemulsification of the nucleus. Total phacoemulsification energy and time were recorded. A heparin-surface-modified intraocular lens or a regular poly(methyl methacrylate) lens, both having the same design and a 5.0 mm optic, was implanted in the capsular bag with the aid of sodium hyaluronate (Healon). Mean endothelial cell loss was 4%. However, the change in cell density did not correlate with the total phacoemulsification energy used during surgery. Three months after surgery, the central corneal thickness was the same as it had been preoperatively. The results suggest that phacoemulsification in the posterior chamber is a safe procedure even in cases with a hard nucleus.

Aged↗
PubMed1990

Phacoemulsification and intraocular lens implantation in patients with cataract. Experiences of a beginning 'phacoemulsification surgeon'.

Phacoemulsification was performed in 125 eyes (123 patients) selected from 145 eyes (143 patients) referred for planned extracapsular cataract extractions and intended posterior chamber intraocular lens implantations. These procedures were the first clinical phacoemulsification operations performed by the author. In the total material, lesion of the posterior capsule or zonules occurred in 7 eyes (4.9%). Vitreous loss occurred in 3 of these eyes (2.1%). In cases with vitreous loss the operative strategy was changed to implantations of anterior chamber lenses. Five of the 7 eyes that experienced intraoperative complications, had preoperative complicating conditions other than cataract. Visual acuity 6 to 12 weeks postoperatively was 6/12 or better in 87% (126/145) of the eyes. Excluding preoperative posterior segment pathology, 98.4% (126/128) achieved this visual acuity. This study demonstrates that it is possible to include phacoemulsification as the main treatment modality in planned ECCE operations without significant increase in complication rates even for a 'beginning phacoemulsification surgeon'.

Adult↗
PubMed2001

[Phacoemulsification and vitrectomy with the erbium:YAG laser and phacoemulsification with the neodymium:YAG laser].

There are an increasing number of possible applications for the use of Erbium:YAG and Neodymium:YAG lasers in ophthalmology. Laser-phacoemulsification as well as Erbium-laser vitrectomy is of major interest. We report on the underlying technology and more than 1-year-experience using the PHACOLASE (Asclepion-Meditec, Jena, Germany, 10-100 Hz frequency, 5-50 mJ single pulse energy) for phacoemulsification and pars plana vitrectomy and the Lyla-Dodick laser photolysis (A.R.C. Laser, Eckental-Forth, Germany, 1-20 Hz, up to 8 mJ single pulse energy). The Erbium:YAG-laser as well as the Neodymium:YAG-laser enabled us to extract lenses with up to medium hard nuclei. Moreover, the Erbium laser enabled fast vitrectomy with little mechanical traction. In many of our initial surgical operations we had to change to mechanical vitrectomy due to initial technical problems. No new complications occurred intra- or postoperatively. The handpiece worked well in removing vitreous bodies, but was not feasible for cutting membranes. Modified handpieces for this purpose are under development.

Equipment Design↗
PubMed1999

Combined surgery for cataract and glaucoma: phacoemulsification and deep sclerectomy compared with phacoemulsification and trabeculectomy.

PURPOSE: To compare the outcome of phacoemulsification-intraocular lens (IOL) implantation combined with nonperforating deep sclerectomy (P-DS) with that of phacoemulsification-IOL implantation combined with trabeculectomy (P-T). SETTING: Glaucoma Unit, Department of Ophthalmology, University of Lausanne, Switzerland. METHODS: This prospective study involved 60 eyes of 60 patients with cataract and various types of open-angle glaucoma. Thirty eyes had P-DS and 30, P-T. Follow-up was performed at regular intervals for up to 18 months. RESULTS: Mean follow-up was 12.5 months +/- 6.5 (SD) and 12.6 +/- 4.9 months for the P-DS and P-T groups, respectively. Mean preoperative intraocular pressure (IOP) was similar in both groups (24.8 +/- 5.9 mm Hg in the P-DS group and 24.6 +/- 7.2 mm Hg in the P-T group). There was no statistically significant difference in IOP decrease (14.2 +/- 4.0 mm Hg in the P-DS group and 15.2 +/- 2.8 mm Hg in the P-T group). Visual outcome was similar in both groups. The P-DS group experienced significantly less inflammation (40.0% versus 83.0%; P = .0012) and hyphema (6.7% versus 36.7%; P = .010) than the P-T group. CONCLUSION: Deep sclerectomy combined with cataract surgery resulted in an IOP reduction similar to that with phacotrabeculectomy with the same visual outcome, but the lower complication rate makes ambulatory care easier.

Adolescent↗
PubMed1998

A prospective study of combined phacoemulsification-trabeculectomy versus conventional phacoemulsification in cataract patients with coexisting open angle glaucoma.

This prospective study compares combined phacoemulsification and trabeculectomy (phaco-trab) to conventional phacoemulsification (phaco) in patients with coexisting cataract and open angle glaucoma. Twenty eyes were randomly assigned to either phaco-trab or phaco and followed for 12 months. Postoperatively, IOP decreased significantly in both groups, but patients with the combined procedure had fewer early IOP-elevations and significantly less medication. Visual acuity improved equally in the two groups.

Aged↗
PubMed2002

[Present state of erbium laser phacoemulsification. Comparison with ultrasound phacoemulsification concerning energy and phaco-time at one clinic].

BACKGROUND: Comparison of phaco time and phaco energy between ultrasound (USP) and erbium laser (ELP) phacoemulsification at the Eye Clinic Neubrandenburg. METHOD: One surgeon performed all operations (n = 503) employing only USP (Harmony, D.O.R.C., Groningen, Netherlands). Phaco time was measured and converted to energy. Another surgeon performed all operations (n = 503) using only ELP. The energy transfer and phaco time were read from the Phacolase (Asclepion-Meditec, Jena, Germany). Nucleus hardness distribution was comparable for both surgeons. RESULTS: Phaco times in USP/ELP were as follows: nucleus hardness 0: 0.7 s/7.5 s, nucleus hardness 1: 9.6 s/57.6 s, nucleus hardness 2: 23.7 s/106.9 s, nucleus hardness 3: 39.3 s/215.1 s, and nucleus hardness 4: 68.9 s/232.0 s. Energy in USP/ELP was as follows: nucleus hardness 0: 7.2 J/0.9 J, nucleus hardness 1: 96.7 J/23.5 J, nucleus hardness 2: 237.3 J/53.1 J, nucleus hardness 3: 392.5 J/149.1 J, and nucleus hardness 4: 688.6 J/176.6 J. CONCLUSION: ELP takes longer than USP, but the energy transferred to the eyes for emulsification was lower with the laser in comparison to ultrasound.

Adolescent↗
PubMed2005

Combined cataract and glaucoma surgery with mitomycin C: phacoemulsification-trabeculectomy compared to phacoemulsification-deep sclerectomy.

AIMS: To compare outcomes of phacoemulsification combined with trabeculectomy (PT) or deep sclerectomy (PDS) with intraoperative mitomycin C (MMC) application. METHODS: Non-randomised, consecutive, retrospective comparative study. 97 eyes of 97 patients (59 PDS, 38 PT) undergoing combined surgery with intraoperative MMC (0.1-0.4 mg/ml for 1-3 minutes) were identified for inclusion in the study. RESULTS: The probability of maintaining intraocular pressure (IOP) below 19 mm Hg and 15 mm Hg, with a 30% drop from preoperative IOP and without additional medication, 1 year after surgery were 77.6% (95% CI: 67 to 90) and 71.5% (60 to 85) for the PDS group and 89.5% (80 to 99) and 89.5 (80 to 99) for the PT group, respectively, and these differences were not statistically significant (p>0.05, log rank test). After excluding ocular co-morbidity no differences were observed in the improvement of visual acuity between the two groups. There were no major differences in the complication rates except that delayed bleb leaks were seen in seven eyes (18.4%) of the PT group (p = 0.004). CONCLUSION: In this study, no statistically significant difference was found in the IOP and visual outcomes between PDS and PT. A significantly higher frequency of late bleb leaks after PT was observed.

Aged↗
PubMed1989

[Protective effect of the anterior lens capsule: corneal endothelial cell loss following intercapsular phacoemulsification compared with phacoemulsification with large open capsulotomy].

In an experimental study using rabbits, the intercapsular technique was performed in 20 eyes to make a small anterior capsulotomy. A large, "can opener" capsulotomy was performed in 20 eyes, and ten eyes (five non-operated animals) served as controls. Endothelial cell loss was determined by vital staining with Trypan blue and Alizarin red S. Average endothelial cell loss with the intercapsular technique was 1.2%; with the can opener technique the cell loss was 6.6%. This difference was statistically significant (p less than 0.01). The percentage in the control eyes was 0.05%. Positive relations between endothelial cell loss related to phacoemulsification time and/or the amount of irrigating fluid used existed for the can opener group only (p less than 0.01). These results demonstrate that the presence of an almost intact anterior lens capsule during removal of lens substance is protective to the corneal endothelium.

Animals↗
PubMed2004

[Phacoemulsification of cataracts after pars plana vitrectomy (comparison of phacoemulsification with pars plana infusion and without pars plana infusion)].

PURPOSE: To compare peroperative complications of standard phaco technique and phaco with pars plana infusion performed for cataract after pars plana vitrectomy. METHOD: This prospective study randomly divided group of 64 patients with cataract after PPV into group A (standard phaco, 38 patients) and group B (phaco with par olana infusion, 26 patients). The study verifies the rate of peroperative complications such as deep anterior chamber, diaphragma movement miosis, and zonular dehiscention in these two groups. RESULTS: Peroperative complications had slightly higher rate in group B (with infusion). No specific complication in group A (standard phaco) was found. CONCLUSION: Standard phaco technic without par plana infusion has at least the same level of safety as phaco with pars plana infusion.

Humans↗
PubMed2005

Outcomes of microincision cataract surgery versus coaxial phacoemulsification.

PURPOSE: To compare outcomes of microincision cataract surgery (MICS) with coaxial phacoemulsification. DESIGN: Prospective randomized consecutive case series. PARTICIPANTS: One hundred eyes of 50 patients with nuclear or corticonuclear cataract (grades 2+ to 4) with Lens Opacities Classification System III. METHODS: One hundred eyes (50 patients) were randomly operated through clear corneal incisions using 2 techniques: coaxial phacoemulsification (50 eyes) and microincision cataract surgery (50 eyes). MAIN OUTCOME MEASURES: Mean phacoemulsification time, total phacoemulsification percent, effective phacoemulsification time (EPT) (calculated by multiplying total phacoemulsification time in seconds by the average power percent used), intraoperative total balanced salt solution (BSS) volume, visual outcome, vectorial astigmatic changes, corneal thickness, endothelial cell count, and anterior chamber flare and cells preoperatively and at 1 day, 1 month, and 3 months. RESULTS: Statistically significant differences were found between MICS and coaxial phacoemulsification regarding mean incision size, mean total phacoemulsification percent, and EPT. There were no significant differences between the techniques regarding the mean percent of endothelial cell loss, anterior chamber cell count and flare, mean phacoemulsification time, pachymetric measures or total BSS volume utilized, or visual outcome. The vectorial astigmatic changes in the MICS group showed a change of < or =0.25 diopters (D) in 35% of the eyes, 0.25 to 0.5 D in 50% of the eyes, and 0.5 to 1.0 D in 15% of the eyes. These changes were induced by the surgery. Vectorial astigmatic changes of >1 D were not observed. In the coaxial phacoemulsification group, vectorial astigmatic changes of <0.25 D were not observed either. Changes of 0.25 to 0.5 D were seen in 20% of the eyes, and changes of 0.5 to 1.0 D were seen in 30%. Fifty percent of the eyes showed changes of >1.0 D. Mean vectorial astigmatic changes were 0.36+/-0.23 D in the MICS group and 1.2+/-0.74 D in the coaxial phacoemulsification group (P<0.001). CONCLUSIONS: Microincision cataract surgery significantly lowered mean phacoemulsification time, mean total phacoemulsification percent, mean EPT, and surgically induced astigmatism when compared with coaxial phacoemulsification.

Cataract Extraction↗
PubMed2002

Phacoemulsification in eyes with functioning filtering blebs: a prospective study.

OBJECTIVE: To evaluate the effect of phacoemulsification on intraocular pressure (IOP) control in eyes with a previous functioning filtering bleb and no glaucoma medication. DESIGN: Prospective, nonrandomized comparative (self-controlled) trial. PARTICIPANTS: Forty-seven patients (49 eyes) who underwent phacoemulsification after successful trabeculectomy, with at least 12 months of follow-up. INTERVENTION: Clear corneal phacoemulsification and implantation of a foldable intraocular lens in eyes that underwent a previous successful trabeculectomy. The time between both procedures was always greater than 1 year. MAIN OUTCOME MEASURES: Preoperative and postoperative IOP, the number of glaucoma medications, bleb appearance, and visual acuity were recorded at each follow-up examination. Success was defined as no need for glaucoma medications, bleb needling, or further glaucoma surgery for IOP control after phacoemulsification. Preoperative and intraoperative factors were evaluated for an association with postoperative failure using Kaplan-Meier survival analysis. RESULTS: The mean (+/- standard deviation) IOP before phacoemulsification was 12.24 (+/- 4.68) mmHg, and it increased 3.94, 3.76, 1.39, 2.04, and 1.57 mmHg on the first postoperative day, after 1, 6, and 12 months, and at the last visit, respectively. At each interval, the mean IOP was significantly higher than the preoperative value (P = 0.000, 0.000, 0.049, 0.01, and 0.01, respectively). Nevertheless, the mean IOP after phacoemulsification was always lower than before trabeculectomy (P = 0.000). At the last visit, glaucoma medication was required in 17 eyes (34.7%). The success rates after phacoemulsification were 83.6%, 68.2%, and 55.7% at 6 months and 1 and 2 years, respectively (Kaplan-Meier survival analysis). The number of glaucoma medications used increased at all follow-up visits (P < 0.005). Bleb size decreased after phacoemulsification (P = 0.000). An IOP before phacoemulsification of greater than 10 mmHg was associated with postoperative failure (P = 0.002). Similarly, bleb failure and the need for glaucoma medication were associated with higher IOPs before phacoemulsification. CONCLUSIONS: Phacoemulsification significantly increased IOP and the number of glaucoma medications in eyes with preexisting functioning filtering blebs. Eyes with higher IOPs before phacoemulsification had worsened postoperative IOP control and bleb failure.

Aged↗